Articles and Blogs

On March 1, 2016, the Department of Justice (“DOJ”) released a statement describing a settlement with the United States’ largest endoscope distributor (“Company”) to resolve civil claims and criminal charges connected to payments and kickbacks made to physicians and hospitals. The Company agreed to pay a total of $623.2 million to settle the criminal penalties…Read More

Overview On March 1, 2016, the Centers for Medicare & Medicaid Services (“CMS”) issued a Proposed Rule that would make several sweeping changes to the Medicare screening and enrollment requirements for providers and suppliers. In particular, the Proposed Rule would require providers and suppliers to report certain affiliations with other providers/suppliers that may pose a…Read More

Executive Summary The Centers for Medicare & Medicaid Services (“CMS”) recently released a memo to Medicare Advantage and Part D plan sponsors (collectively, “Sponsors”) providing additional guidance regarding Compliance Program Effectiveness (“CPE”) training requirements applicable to a Sponsor’s first tier, downstream and related entities (“FDRs”), including a Sponsor’s contracted health care providers and subcontractors. In…Read More

House Approves Legislation to Reduce Medicaid Fraud On March 2, the House of Representatives unanimously passed a bill to improve program integrity in Medicaid and CHIP. The Ensuring Removal of Terminated Providers from Medicaid and CHIP Act (H.R. 3716) would help states identify health care providers whose participation in Medicaid or CHIP was terminated in…Read More

Overview Since the passage of the Affordable Care Act, all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new screening criteria. The Centers for Medicare & Medicaid Services (“CMS”) has implemented this requirement in two cycles. The first cycle of revalidation requests has concluded, and CMS is preparing to…Read More

Overview In recent years, the Centers for Medicare & Medicaid Services (“CMS”) has been committed to enforcing the requirement that hospitals must be “primarily engaged” in providing inpatient services to be qualified as a hospital under the Social Security Act and thus eligible to participate in Medicare.  This enforcement trend has resulted in the termination…Read More

We’ve blogged in the past about employees caught sleeping on the job. Most employers would say that an employee who is caught sleeping on the job will usually end up getting fired, and that is usually fine! However, where that employee suffers from a disability or a serious health condition, an employer will need to…Read More

Energy and Commerce Committee Republicans Question Medicaid’s Use of Provider Taxes On February 18, House Energy and Commerce Subcommittee on Health Chairman Joe Pitts (R-PA) and Vice Chairman Brett Guthrie (R-KY) sent a letter to CMS regarding the lack of oversight in how state Medicaid programs use provider taxes to pay for their expenditures. Pitts…Read More

Starting at the beginning of 2016, the Equal Employment Opportunity Commission (“EEOC”) has changed its procedures when it comes to employer position statements submitted in response to charges of discrimination. Now, the EEOC will release complete employer position statements and attachments to any charging party and their attorney who request release. In the past, the charging…Read More

The Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”), signed by President Obama in April of 2015, enacted legislation that will significantly impact provider reimbursement. MACRA repealed the Sustainable Growth Rate (“SGR”) formula and implemented: (i) scheduled updates to the Medicare Physician Fee Schedule (“MPFS”) including a 0.5 percent positive annual update beginning July…Read More